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For instance, cancer survivors may be denied health insurance in some states because of their cancer history, or may have to pay extra to receive coverage. And even insured patients may still struggle to pay for prescriptions or other care. The report suggests federal support for state programs that provide insurance for high-risk residents, as well as expansion of federal programs that offer services like screening to lowincome people. And it says government and private insurers should expand their coverage of survivorship-related care. That recommendation is key for implementing many of the reports other suggestions, Teschendorf said. Theres no reimbursement code for follow-up clinics now, she explained. This is a springboard to figure out how Medicare and private insurers would pay for this type of visit. The full report is available to read online or purchase from the National Academies Press at http://www.nap.edu/catalog/ 11468.html. Related resources, including fact sheets for survivors and doctors, can be downloaded from the Institute of Medicine Web site (http://www.iom.edu/report.asp?id 30869).
A CANCER TREATMENT IN THE SPICE CABINET?

A growing body of research suggests the spice turmeric has potent anticancer activity and researchers have launched a slew of human trials to find out just how powerful it may be. I think the promise is enormous, said Bharat Aggarwal, PhD, Professor of Cancer Research, Cancer Medicine, and Chief of the Cytokine Research Laboratory in the Department of Experimental Therapeutics at the University of Texas MD Anderson Cancer Center. Aggarwal has conducted numerous in vitro and animal studies of turmeric and its primary com-

ponent, curcumin (diferuloylmethane), and recently gave a lecture discussing Curcumin as a Paradigm for Nutrition-based Therapy at the annual conference of the Society for Integrative Oncology. Turmeric and curcumin are antiinflammatory, Aggarwal said. That has been described in traditional medicine like Ayurveda for thousands of years. More recently, Aggarwal and colleagues have shown that curcumin inhibits inflammation by reducing activation of the I B kinase/ NF- B pathway. As researchers have come to understand the role inflammation plays in cancer, they have grown more interested in the ability of curcumin to prevent or treat this disease. NF- B plays a key role in regulating several other cellular processes such as apoptosis and cell proliferation, suggesting curcumin might exert anticancer activities independent of its inhibition of inflammation. And, recent preclinical studies have documented that curcumin can inhibit angiogenesis, induce apoptosis, and slow metastasis. Whats more, these effects do not appear to be limited to just one type of cancer. Curcumin has shown effects against metastatic melanoma (Cancer 2005;104:879-890), mantle cell lymphoma (Biochemical Pharmacology 2005;70:700 713), and other cancers. Most recently, Aggarwal published a study in the journal Clinical Cancer Research (2005;11:7490 7498) showing that dietary curcumin inhibited lung metastases in mice with advanced human breast cancer. In addition, it appeared to moderate the toxicity of paclitaxel and enhance the drugs positive effectsanother potential benefit to using curcumin more broadly in cancer therapy. However, at least one laboratory study also suggests that curcumin may inhibit the proapoptotic action of camptothecin, mechlorethamine, and doxorubicin in vitro and the antitumor activity of cyclophosphamide against

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human breast cancer xenographs in athymic mice, raising concern regarding its therapeutic use until the completion of clinical trials that are currently underway. At MD Anderson Cancer Center alone, Aggarwal said, doctors are exploring the effect of curcumin on multiple myeloma, and whether it can improve outcomes for people with advanced pancreatic cancer. The institution is also seeking funding for a study of curcumin in women with breast cancer, he said. Studies from other institutions, both in the United States and overseas, are looking at curcumin as

a potential treatment for myelodysplastic syndromes, and for preventing colorectal cancer in individuals with familial adenomatous polyposis or with sporadic polyps. Another aspect of curcumin that makes it appealing for cancer therapy and prevention is its apparent lack of serious side effects, Aggarwal said. Although high doses and prolonged use may cause stomach irritation or upset in some people, Aggarwal said studies have found no serious toxicity, even at doses as high as 8 to 12 g/day. American Cancer Society, Inc., 2006.

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